HOUSE AMENDMENT

    hbd-31                           Bill No. CS/HB 1659, 1st Eng.

    Amendment No.     (for drafter's use only)

                            CHAMBER ACTION
              Senate                               House
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 5                                           ORIGINAL STAMP BELOW

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10                                                                

11  Representative(s) Wasserman Schultz offered the following:

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13         Amendment (with title amendment) 

14         On page 86, between lines 2 and 3 of the bill

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16  insert:

17         Section 48.  Present subsections (4), (5), (6), (7),

18  (8), (9), and (10) of section 641.51, Florida Statutes, are

19  redesignated as subsections (5), (6), (7), (8), (9), (10), and

20  (11), respectively, and a new subsection (4) is added to that

21  section to read:

22         641.51  Quality assurance program; second medical

23  opinion requirement.--

24         (4)  A health maintenance organization must ensure that

25  only a physician licensed under chapter 458 or chapter 459,

26  Florida Statutes, may make the final decision on an adverse

27  determination regarding a service provided by a physician

28  licensed under chapter 458 or chapter 459, Florida Statutes.

29  The physician making the final decision shall be required to

30  submit, in writing, to the provider and the subscriber, the

31  facts and documentation regarding the health maintenance

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    File original & 9 copies    05/03/00
    hbd0007                     07:02 am         01659-0097-522567




                                                   HOUSE AMENDMENT

    hbd-31                           Bill No. CS/HB 1659, 1st Eng.

    Amendment No.     (for drafter's use only)





 1  organization's adverse determination within 2 working days

 2  after the subscriber or provider is made aware of the adverse

 3  determination.  Such physician shall also be required to sign

 4  the adverse determination.  The health maintenance

 5  organization must include, with the notification of an adverse

 6  determination, information explaining the appeals process for

 7  adverse determinations. 

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10  ================ T I T L E   A M E N D M E N T ===============

11  And the title is amended as follows:

12         On page 6, line 18,

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14  after the semicolon insert:

15         amending s. 641.51, F.S., relating to quality

16         assurance program requirements for certain

17         managed care organizations; restricting the

18         rendering of adverse determinations to certain

19         physicians regarding certain services;

20         requiring the submission of facts and

21         documentation pertaining to rendered adverse

22         determinations; providing a timeframe for

23         organizations to submit facts and documentation

24         providers and subscribers, in writing, of

25         adverse determinations; requiring physicians

26         who render adverse determinations to sign the

27         facts and documentation statement; requiring

28         the organization to include information

29         regarding the appeal processing;

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    File original & 9 copies    05/03/00
    hbd0007                     07:02 am         01659-0097-522567